I thought I read it all to prepare myself for childbirth. But I was caught completely off guard by my postpartum cramps. Here's what pregnant people need to know.

By Devan McGuinness
March 19, 2020
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Credit: Burak Karademir/Getty Images

A planner by nature, I wanted to be as prepared as I could be for pregnancy, labor, birth, and postpartum. I thought I'd researched it all, but after my first baby was born I was still in a whole lot of pain. For me, the pain was very similar to contractions or really bad menstrual cramps. It felt like a fire in my pelvis and lower back that came and went with timed surges. It was intense, and at times, almost as intense as labor. I just assumed the 12-plus hours of labor that ended in a dramatic episiotomy and quick delivery was to blame.

But I experienced the same pain after my second child, and again after I had my third. By the time I had my fourth child, the pain had intensified, and I knew this was no fluke.

Turns out I was suffering from postpartum cramping, something I didn't come across in my pre-baby research. I was finally able to put a name to it when I talked to my mom, who had four children of her own. These cramps were so bad for her, also, that she knew right away the name of the pain I was feeling. Postpartum cramps are a real thing, but why aren't more people talking about them?

What Are Postpartum Cramps?

Postpartum cramps are commonly called "afterbirth pains" and, although painful, are totally normal, according to Rachel Borton, Ph.D., director of the Family Nurse Practitioner (FNP) online program and assistant professor of nursing at Bradley University. The cramping is caused as "the uterus is shrinking back to its normal, smaller size," says Dr. Borton. (It typically takes about six weeks for your uterus to shrink to its regular size, according to March of Dimes.)

The hormone oxytocin, which is made in the hypothalamus (part of the brain) and the placenta, is to blame for these uterine contractions; yes, the same hormone that led to labor progressing, and the same one that your body releases when you breastfeed.

These contractions happen in every uterus that's given birth, but the pain is individual. "Not all women experience postpartum cramps," says Sharyn N. Lewin, M.D., FACS, FACOG, a board-certified gynecologic oncologist and women's health and wellness specialist and medical director at Holy Name Medical Center's gynecologic oncology division in Teaneck, New Jersey. "For the majority, discomfort is mild and relieved with Motrin or Tylenol."

And it turns out my experience of my postpartum cramps being more painful after subsequent births is relatively common, too. "Sometimes with first-time delivery moms, they aren't as noticeable, but typically with the second delivery the body is quick to remember, and moms will report that pain quickly and a little more severe," says Dr. Borton.

They are also likely for people who are carrying multiple babies. "Afterpains are more common in women in who the uterus was overdistended," says Dr. Lewin.

How Long Do Postpartum Cramps Last?

Thankfully, afterbirth pain doesn't usually last as long as it takes for the uterus to go back to normal. The cramping "typically only lasts two to three days following delivery," says Dr. Borton. Dr. Lewin confirms that since postpartum cramps are typically "mild," they should "resolve within one week of delivery."

There are also ways to ease the pain. New parents experiencing afterbirth pain can opt for over-the-counter medicine. Dr. Borton says nonsteroidal anti-inflammatory drugs (NSAIDs), such as Motrin, as well as acetaminophen like Tylenol, are usually enough to ease the pain, and they're safe to take while breastfeeding.

The same tricks that work during a painful period or early labor can help bring comfort, too. Think things like applying a heating pad or a hot water bottle on your lower abdomen.

After my fourth pregnancy, I opted for both a compression garment, which Dr. Lewin agrees is safe to use after delivery, as well as NSAIDs, and that made the pain level far more tolerable.

When to Call a Doctor About Postpartum Cramps

There are times when afterbirth cramps may be a cause for concern. "If the cramps are unrelieved by Motrin or Tylenol and feel like a 'sharp' stabbing pain," says Dr. Borton, you should contact a medical professional to make sure all is OK. The same goes for if you notice any unusual discharge or smell, or spike a fever.

Dr. Lewin says any temperature at or above 100.4 degrees for at least two days within the 10 postpartum days, not including the first 24 hours after birth, are cause for concern, whether postpartum cramps are experienced or not. "This requires work up by your physician," says Dr. Lewin.

If you were also caught off guard by the postpartum cramps when you thought you read and researched it all, you're not alone. This is one part of labor and birth that we don't talk about enough, and since it seems to impact parents during subsequent pregnancies, we have to remember that even if we've gone through this before, every labor, birth, and recovery is different.

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